Active NPI
Kathleen Deal Tatum, LCSW
- Clinical Social Worker
- Jesup, GA
National Provider Identifier
1366901712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CSW008165
- Practice address
- 296 Turpentine Cir
Jesup, GA 31545-2574 - Phone
- (912) 424-6134
- NPI assigned
- Mar 15, 2019
- Last updated
- Jul 16, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW008165 | GA | Primary |
Addresses
Primary practice location
296 Turpentine Cir
Jesup, GA 31545-2574
Mailing address
296 Turpentine Cir
Jesup, GA 31545-2574
Phone (912) 424-6134
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CSW008165 | Other | GA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSW008165 | GA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721088000000",
"number": "1366901712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "296 TURPENTINE CIR",
"city": "JESUP",
"state": "GA",
"postal_code": "315452574",
"telephone_number": "912-424-6134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "296 TURPENTINE CIR",
"city": "JESUP",
"state": "GA",
"postal_code": "315452574",
"telephone_number": "912-424-6134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATUM",
"first_name": "KATHLEEN",
"middle_name": "DEAL",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-03-15",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW008165",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "CSW008165",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jesup, GA
- Holli Joy Stevens, P.T,, D.P.T.
- Michelle Bianca Stevens
- Deborah Carol Stively, APRN
- Surgery Center of Bji, LLC
- Joanie Swanson, CCC-SLP
- William Ralph Taylor III
- The Grounding Space Counseling and Consulting, LLC
- The Howard Center for Social Cognition and Communication
- The Neurological Institute of Savannah & Center for Spine P C
- Eddie D. Thomas, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.